Table 5.
Barriers to the process of psychiatric deinstitutionalization
| Category | Descriptive themes | References |
|---|---|---|
| 1. Planning, leadership, and funding | Mental health policy: Responsibility/accountability | Rose, 1979 |
| Reform fragility: charismatic leadership | PAHO, 2008 | |
| Reform fragility: Lack of synchronization between bed reduction and development of CBMHSs | Freedman and Moran, 1984; Shen and Snowden, 2014 | |
| Reform fragility: Unaccountability of failure | Rose, 1979; Freedman and Moran, 1984; Rosenheck, 2000 | |
| Funding: Continuity of community care | Mechanic and Rochefort, 1990; McCubbin, 1994; PAHO, 2008 | |
| Funding: Hospital funds not reallocated to CMHS | Fakhoury and Priebe, 2002; PAHO, 2008 | |
| 2. Knowledge/Science | Conceptual limitations and ambiguities | Bennett and Morris, 1983; Freedman and Moran, 1984; McCubbin, 1994; Mallik et al., 1998; Fakhoury and Priebe, 2002 |
| Evidence: Lack of evidence on DI processes | Shen and Snowden, 2014 | |
| Lack of research and innovation on alternatives to institutionalization | Bennett and Morris, 1983 | |
| 3. Power, interests, and influences | Irrelevance of Mental Health in the political/policy agenda | Mechanic and Rochefort, 1990; Semke, 1999; PAHO, 2008 |
| Market factors fostering reinstitutionalization | Rose, 1979; Barton, 1983; Freedman and Moran, 1984; Dorwart et al., 1991; Fakhoury and Priebe, 2002 | |
| Uncoordinated and fragmentary advocacy actions. | Mechanic and Rochefort, 1990; McCubbin, 1994; Rosenheck, 2000 | |
| Vested interests: Pharmaceutical | McCubbin, 1994 | |
| 4. Services and supports in the community | Centralized System | Kleiner and Drews, 1992 |
| Patients: Challenging behaviors | Allen et al., 2007 | |
| Patients: Old Age | Barry et al., 2002 | |
| Services: Hospital-centric models and practices | Bennett and Morris, 1983; Kaffman et al., 1996 | |
| Early discharge | Stelovich, 1979; Kleiner and Drews, 1992 | |
| Services: Lack of services and support in the community | Weiss, 1990; McCubbin, 1994; Fakhoury and Priebe, 2002; Oshima and Kuno, 2006 | |
| Housing: Inadequate, insufficient | Mechanic and Rochefort, 1990; PAHO, 2008; Grabowski et al., 2009 | |
| Dependence on disability benefits and/or pensions | Freedman and Moran, 1984; Chopra and Herrman, 2011; Manuel et al., 2012 | |
| Patients: Disempowerment/Fatalism | Chopra and Herrman, 2011 | |
| Insufficient Public Support | Manuel et al., 2012 | |
| Patients: No money | Goering et al., 1984 | |
| Clashing views on DI within the Workforce | Kleiner and Drews, 1992; PAHO, 2008 | |
| 5. Workforce | Shortages in general | Schmidt, 2000; Fakhoury and Priebe, 2002; Shen and Snowden, 2014; WHO, 2014 |
| Shortages of specific professions | Ash et al., 2015 | |
| Inadequate training | Barton, 1983; PAHO, 2008; WHO, 2014; Mayston et al., 2016 | |
| Moral concerns and fears | Kleiner and Drews, 1992; PAHO, 2008; Ash et al., 2015 | |
| Pessimism | Cohen, 1983; Kleiner and Drews, 1992; Aggett and Goldberg, 2005 | |
| Practices of exclusion | Bryant et al., 2004; Chakraborty et al., 2011 | |
| Stigma in workforce | Barton, 1983; Semke, 1999 | |
| Vested interests: Workforce | Swidler and Tauriello, 1995; Shen and Snowden, 2014 | |
| 6. Communities and the public | Communities are hostile toward users | Bredenberg, 1983; Fakhoury and Priebe, 2002; Aggett and Goldberg, 2005; PAHO, 2008; O’Doherty et al., 2016 |
| Communities are ill-prepared to integrate users | Bredenberg, 1983; Fakhoury and Priebe, 2002 | |
| Public acceptance of social control | Swidler and Tauriello, 1995; Fakhoury and Priebe, 2002; Allen et al., 2007 | |
| Stigma and self-stigma | Mechanic and Rochefort, 1990; Fakhoury and Priebe, 2002; Aggett and Goldberg, 2005; ; PAHO, 2008Manuel et al., 2012; Chan and Mak, 2014; O’Doherty et al., 2016 | |
| 7. Family/Carers | Broken ties between families and services | Aggett and Goldberg, 2005 |
| Lack of support and/or unfair expectations toward families | Barton, 1983; Mechanic and Rochefort, 1990; Oshima and Kuno, 2006; ; Yip, 2006; Lavoie-Tremblay et al., 2012 | |
| Skepticism and Opposition from families | McCubbin, 1994; Oshima and Kuno, 2006 |